LAKE STREET FAMILY DENTAL PA
NPI: 1083096085
· MORA, MN 55051
· Dentist
· NPI assigned 06/25/2015
Provider Details
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
118 |
$0.00 |
| 2019 |
190 |
$7K |
| 2020 |
48 |
$2K |
| 2021 |
37 |
$789.61 |
| 2022 |
123 |
$5K |
| 2023 |
182 |
$7K |
| 2024 |
144 |
$5K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
258 |
256 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
388 |
377 |
$10K |
| D1206 |
Topical application of fluoride varnish |
128 |
125 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$818.34 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$439.39 |
| D0330 |
Panoramic radiographic image |
15 |
13 |
$0.00 |